Grievance Specialist

Job Description

A bit about this role:
As a Grievance Specialist at Devoted Health, you will play a vital role in resolving member grievances with accuracy, efficiency, and compassion. You’ll ensure cases are handled in compliance with regulatory requirements and within established time frames, while also helping build trust with our members. This role requires strong attention to detail, excellent communication skills, and the ability to work across teams to ensure grievances are resolved fairly and thoroughly.

This position is ideal for someone who is detail-oriented, empathetic, and committed to both regulatory compliance and delivering an exceptional member experience. You will help identify opportunities for process improvements, strengthen member relationships, and contribute to Devoted’s mission of caring for every person like family.

• Maintain up-to-date knowledge of Devoted Health products, benefits, policies, and procedures
• Support a culture of continuous learning and member advocacy, helping Devoted fulfill its mission
• Conduct thorough investigations by reviewing case details, member records, and relevant policies/procedures for root cause analyst
• Effectively triage work to ensure grievances are accurately categorized and routed
• Communicate with members through both written correspondence and telephone contact, meeting all regulatory requirements while fostering trust
• Complete accurate documentation and data entry across multiple systems
• Ensure all grievances are resolved within required regulatory and departmental timelines
• Collaborate with internal partners to gather information and resolve cases thoroughly
• Contribute to identifying themes and opportunities for improvement in processes or member experience

• Experience with Medicare Advantage appeals and grievances
• Strong attention to detail and commitment to data accuracy
• Adaptability:
  Handles changing regulations, priorities, or case volumes with resilience and teamwork.
• Excellent customer service and conflict resolution skills, particularly when interacting with members who may be frustrated or vulnerable
• Strong time management and organizational skills, with the ability to meet deadlines consistently
• Ability to work both independently and as part of a collaborative team
• Strong written and verbal communication skills, with the ability to clearly and concisely explain complex information

• Bachelor’s degree or equivalent experience in healthcare, conflict resolution, or related field (Medicare experience required)
• Working knowledge of insurance products, policies, procedures, and claims processes
• Superior investigative, analytical, and problem-solving skills
• Experience escalating cases and collaborating with internal stakeholders when additional support is needed
• Strong computer and documentation skills, with comfort using multiple platforms

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Salary range: $23-$26 per hour

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer…